Do you have a question for the Doc? (Full Version)

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Dr.Wagner -> Do you have a question for the Doc? (May 16, 2007 2:24:00 PM)

Please, list a question (medical preferred) and I will do my best to answer!




VagusX -> Re: Do you have a question for the Doc? (May 16, 2007 4:03:00 PM)

I have a patient with a new LE hinged external fixator 5/7/07 following a non union tibial osteotomy.

At the location of one of the pins superior to the patalla, the skin around the pin appears to be getting streched out with knee flexion. The superficial area around the pin appears to be tearing. The wound is ~3-4 mm deep around the pin, no signs of infection with a small amount of blood. What would be the best way to treat this wound and to avoid further trauma?
\
Thanks

Dan




SJBird55 -> Re: Do you have a question for the Doc? (May 16, 2007 5:58:00 PM)

How dangerous are you after drinking energy drinks?

Can visceral pathologies be a factor with headaches? (I know the liver can with hepatitis... anything else though?)




Dr.Wagner -> Re: Do you have a question for the Doc? (May 17, 2007 9:30:00 AM)

vagus:
Generalized local wound care, bacitracin cream would be fine and clearly making sure the area is cleaned by the patient. No real magic to it, just making sure it doesn't get infected...these sights do amazingly well in young healthy individuals without comorbid states!


SJ

Well, I thought you had dropped off the face of the earth. I need the energy drinks, therefore I am dangerous WITHOUT them.
Visceral pathologies and headaches...you have to have a SUBSTANTIAL hepatitis/cirrhosis to have ammonia levels high enough to cause headaches. But I suppose ANYTHING can cause migraines (stress, hormones, foods etc), therefore in the patients with low threshold migraines...anything can be a trigger.




SJBird55 -> Re: Do you have a question for the Doc? (May 17, 2007 1:16:00 PM)

I always check in on your little section here! Just hanging elsewhere, Wags. :) You can email me any time! (communication works both ways, ya know?)

Patient (70-80 year old) had a past history of hepatitis, back in the 60's or 70's while in the military. Unsure what kind of hepatitis because he doesn't recall. On initial visit he didn't feel well, but I thought maybe flu or ate something? In 4 visits, headaches resolved and doing great. On 5th visit: profuse sweating, night sweats, abdominal fullness, lack of appetite, discomfort right upper quadrant, nausea, diarrhea, insomnia, his eyeballs and skin don't appear jaundiced to me... full blown headache again. Headache reported to be 8-10 level of pain (same as initial visit). Had been hospitalized for pneumonia/bronchitis approximately 3 weeks prior to initiation of outpatient PT services. Has never had a history of headaches. Anyways, I contacted PCP and diagnostic test ordered - CT scan. The condition just didn't seem musculoskeletal in nature to me. I was just curious if I was thinking correctly that something visceral in nature might be occurring.




Dr.Wagner -> Re: Do you have a question for the Doc? (May 18, 2007 10:40:00 AM)

Wow, sounds like he needed some labs drawn...maybe he's having an exacerbation of the hepatitis.

A CT of his abdomen was ordered correct?
What were his vitals?




SJBird55 -> Re: Do you have a question for the Doc? (May 19, 2007 7:28:00 AM)

Yeah, CT of abdomen. You know, I didn't check his vitals this time. On his first visit they were fine - it was wrong for me to have assumed the vitals would be fine this time. I don't do temperature which would have been more relevant than BP or pulse, in my opinion.




Dr.Wagner -> Re: Do you have a question for the Doc? (May 19, 2007 2:48:00 PM)

Guy sounds like he is full of ascites...liver failure...but this is based on description only.




SJBird55 -> Re: Do you have a question for the Doc? (May 19, 2007 8:17:00 PM)

Strange, I just called the guy. CT scan was normal. Bloodwork results aren't in yet. Headache still present. He has an appointment with specialist (gastro I suppose, patient didn't know) on Wednesday. He still feels crappy. Poor guy, don't ya hate that? I always wonder how long it takes from the beginning of symptoms until diagnostic tests actually show a problem.




Dr.Wagner -> Re: Do you have a question for the Doc? (May 20, 2007 1:10:00 AM)

Its so funny, usually patients come to the ER for stuff like this...




SJBird55 -> Re: Do you have a question for the Doc? (May 20, 2007 7:48:00 AM)

Rural folks... they grin and bear it. (He's definitely not grinning - he definitely looks like he's not feeling well.) They have to be dragged while kicking and fighting to go to the doc. LOL I had to convince the guy to make an appt with the doc. Now he's going through the wonderful diagnostic process.




Dr.Wagner -> Re: Do you have a question for the Doc? (May 25, 2007 7:27:00 AM)

bump




Tom Reeves DPT ATC -> Re: Do you have a question for the Doc? (May 25, 2007 8:42:00 AM)

OK I have one.

16 year old track athlete. Runs middle distance, runs good times, low 50s in the 400, 2:09 or so in the 800. Has been complaining of L calf pain that worsens when he runs. He has been warming up then seeing if he can tolerate running. After his last 400 he couldn't walk because of the burning in his calf. He says that his coach would rub his calf muscles and it would help. Describes some turgidity but no numbness.

He saw his primary care MD (family practice) who did a diagnostic US that was negative for DVT. He has no pedal edema, only pain.

Came to me for an athletic screening (after the doc visit is not what they are intended to be but hey, what the heck) Late in our visit after finding minimally tight gastrocs and very minimal forefoot varus did he say that he remembered having to take his shoes off sometimes during basketball because of numbness in the sole of his L foot.

I sent him back to have compartment syndrome ruled out. Anyone ever see a non-traumatic posterior compartment syndrome? I have only seen it in the anterior compartment.




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